EC Gynaecology

Management of ectopic pregnancy has improved globally in the past four or so decades, resulting in reduced associated morbidity and mortality, despite an increase in its incidence. Improved awareness, availability of and access to quality healthcare services, as well as diagnostic capabilities, have enabled early and accurate diagnosis thereof.

Early diagnosis gives the clinicians a wider range of treatment options among which is the medical approach using intramuscular methotrexate, a folic acid antagonist. This is now widely used as first-line treatment for haemodynamically stable patients. It however has its limitations and requires adherence to strict guidelines and instructions. The patient is required to make weekly follow up visits, after initiating treatment, with estimation of β-hCG level until it drops to non-pregnant levels, which considered an indicator of successful treatment among other instructions.

While methotrexate has been and continues to be used successfully for the treatment of ectopic pregnancy in developed countries, its use in developing countries such as those in sub-Saharan Africa remains very limited. There’s paucity of published data from the Region despite having the highest incidence rates of ectopic pregnancy globally. However there’re potential opportunities for its use in the region, if we address the related challenges.

This paper presents an initial experience with the use of methotrexate in East Africa by the author. It shows possible opportunities and situations it can be used successfully while highlighting inherent challenges with its use.

 Keywords: Ectopic Pregnancy; Methotrexate; Opportunities and Challenges; Developing Counties

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